As an opening statement I will say we have seen the severe risks and serious problems arising from the current approach of osteoclast-inhibiting medications that have been almost universally touted by the medical community, and the chronic denial of the problems of what contributes and exacerbates bone health. The list is long and well documented, yet relatively hidden from public view. Hopefully, our discussion here will dispel the dearth of knowledge that needs to be in the hands of health professionals and consumers alike. There are solutions, from avoidance of certain substances like caffeine and certain medications to changing diet, hydration, and rebuilding bones at the consumer and lifestyle level. Thank you in advance, those who contribute to this important question, for your well considered and knowledgable insights. 

For maintaining strong bones, it is recommended to intake of calcium is at least 700 mg a day. Vitamin D is also important for healthy bones and teeth because it helps your body absorb calcium. There are many factors that can prevent osteoporosis, such as, quitting smoking and avoid alcohol intake.

Although I am not a specialist at this field, I agree that an unbiased approach is necessary for obtaining a real improvement. I don't know how was the medicine affairs at the past, but today when I hear about a research method I tend to be suspicious due to the enormous interdependence between doctors and companies. I hope to be able to find something new!

Mahfuz & Cecilia- Yes, calcium and vitamin D but we find almost all commercial grade calcium fraught with nonabsorbance--the only one that we recommend and find actually builds depleted bones back up without leaving a trail of atherosclerosis, cataracts, kidney stones, bone spurs, etc., is not really available through standard commercial channels and that is microcrystalline hydroxyapatite concentrate (known as MCHC). MCHC is made from New Zealand sheep bones and is captured in live ionic form (preserving the positive charge so that with the negative charge of the intestinal wall it becomes a complete ion when absorbed into the body) so that enterically one receives a great deal more usable calcium. I know this is a lot to consider, but the great misnomer of the day is consumers have been counseled to take calcium--and we ask, which kind??? The commerically available forms are all dead forms and contribute mightily to unintended issues as raised blood pressure, heretotopic ossicifcation, and the other things mentioned above. Here are a few enlightening sources to consider:

-Brown, S.E. (2014). Osteoporosis risks vs benefits of osteoporosis drugs—spinning the numbers. http://www.betterbones.com/osteoporosis/risks-benefits.aspx.

-Clinical Summary (2014). Evaluation of Nutritional Support with Concentrated Microcrystalline Hydroxyapatite Concentrate. https://nutri-dyn.com/images/LinkedCases/MET1248.pdf

-Goldschmidt, V. (2014). Is Sugar Toxic for Your Bones? http://saveourbones.com/is-sugar-toxic-for-your-bones/.

-Lee L. (1989). "Health effects of microwave radiation-microwave ovens," Lancet

Pines, A., Raafat, H., Lynn, A.H., Whttington, J. (1984). Clinical trial of microcrystalline hydroxyapatite compound in the prevention of osteoporosis due to corticosteroid therapy. Current Medical Research Opinions, 8(10):734-42.

-Villablanca E (December 19, 2007) "Ionizing and non-ionizing radiation: Their difference and possible health consequences.

-Yasuda, H. (2012). New roles of osteoblasts in osteoclast differentiation. http://www.wjgnet.com/2218-5836/pdf/v3/i11/175.pdf.

There are three major things one should does daily

1. eat balance diet rich in calcium and vitamin d2

2. make regular exercise as weight training with high impact sport for bone density increment.

3. expose 25%-40% of your skin some for at least 10-20minutes (depending on your skin pigmentation)  under sunlight condition to make vit. d3. especially when the sun is over 50 degree from horizon.

The above points are the most important factors that make you a way from osteoporosis.

I am not a specialist at this field, but I think the best prophilaxis of osteoporosis is reductio of sitting (TV, computer) and moving, moving moving!

Hashem, I like the "eating" part--because it it is the process and act of eating fresh foods that the body most efficiently gains its nutrition and makes best use of it. The weight bearing exercise and sunlight to make your own Vitamin D (which is a world better and vastly chemically different from the toxic D1 that is often prescribed) is by far the IDEAL in maintaining both bone mass and good health. Nikola's injunction against sedentary lifestyle is so important, too. Now, what of the biophosphenates and alendronates that are routinely prescribed for those suffering with osteoporosis?   

Osteoporosis is irreversible dear Max. People take drug to stop osteoporosis.  They also can do stretching exercise that is easy and passive one.

Now, here is the dilemma, Hashem. The pharmaceuticals are advertising in the US as if their osteoclast inhibiting meds reverse bone loss--they even use those words. Now, we know that is false to the core, because filling the bones with dead cells is not changing anything in a positive direction. In fact, those meds cause terrible harm to the bones and other health factors and to us are the worst possible approach to preserving healthy bone mass. On the other hand, we have seen hundreds of osteoporosis cases that have stopped their advancement cold in their tracks with the things covered above, in every case, and to some extent reversed some of the condition itself. I don't know what your approach is in Jordan, as I know you have to deal with these issues much as we do here, but we focus on overall health, removal of contributing factors, and find vast improvements in the lives of our patients. We find the current medication offerings for bone loss counterproductive and fraught with risks that are not being reported in the larger media. Good health practices can't compete in the business world, but it is by far better for the end user of healthcare services and lightens the financial burden on the public at the same time, as I am sure you find on your end. Thank you for your comments. They are appreciated.

Conventional medicine, as far as I know, since I am a gastroenterologist and therefore am not devoted to the problem, first proposes to assess the extent of osteopenia with a bone densitometry and, subsequently, the use of calcium, vitamin D and etidronate alone or in combination depending on the severity of the problem and the risk of pathologic fracture or vertebral collapse

Of course, densitometry does not distinguish between live and dead cells, so we have found that those taking the biophosphonates and etidronate meds after a number of years are in worse danger of femur fracture and any other fracture that will not heal because of the action of these meds on the patient's bones. We also find that is rare for the patient to receive elucidated prescription to change diet, exercise, hydration, and lifestyle issues at the causal level so they can stop the loss from continuing and improve their lost bone health to the degree possible. In our experience, there is not a need for the types of medicines being prescribed for bone loss but instead a serious need to make the changes mentioned above. 

The best way for healthcare professionals and researchers to combat the huge and recent rise in osteoporosis is to give right advice.  Asian women who have a small frame often have a high rate of osteoporosis.  We need to exercise more and move more.  'The average person today has way too little movement in their life early on, which already impacts bone density and gets even worse as they age, for most have never developed a habit of it in their lifestyle.  Bone builds and re-builds based on its needs. So if you don’t use them, you literally lose them.  Part of this exercise can include daily brisk walking, yoga and various cardio exercises, but the key really is having some resistance or weight training exercise.'

Next, I stay away from an acidic diet (coffee, soda, alcohol and fast, processed foods high in bad fats, excess sugar and salt).

Third, I make sure I get enough sunlight and vitamin D so that the calcium really gets absorbed into the bone matrix to strengthen and harden the bones.

http://www.evolvingwellness.com/essay/preventing-and-reversing-osteoporosis-naturally

Palani, I'm so glad you brought up Yoga. Miranda brought up excellent lifestyle aspects, as well. In the US practically everything the average American eats is dead -- from irradiation, prepared and processed, and if that is not enough, they take it home and finish off what organic nutrition that might be utilized by the body in the microwave ovens. I know the official line on microwave ovens is they are safe, but we see it as detrimental to the human digestive system--in fact, our patients flourish when they stop microwaving and make other needed adjustments in their diet and hydration. But getting back to exercise, Yoga was found in a study in which was co-author to be remarkably effective for combatting aging and chronic diseases. See attached and thanks to you both!

Not being an expert in osteoporosis, I like to highlight one biological fact: This disease is associated with increased chances of bone fracture, while this is inconsistent with de-calcification. The fact is that bone exists of calcium and collagen: remove the calcium and the bone gets more flexible (less prone to fracture), remove the collagen and the bone gets brittle (more prone to fracture). So, someone has to explain to me how osteoporosis got linked with de-calcification rather than with de-collagenation. It makes no sense. The confusion may explain why calcium additives don't work.

Poor nutrition is the most common cause of osteoporosis. A healthy diverse food can help very much. As the person becomes older, it is important to switch from fast food to food cooked at home. I do not think that it is difficult to have a good needed amount of calcium & other supporting vitamins or minerals on a daily basis. The dairy products (milk, yogurt, and cheese) are not that costly worldwide. Fish (not necssarily the expensive types) that has lemon juice on it  with an accompanying serving of potatoes can do wonders to increasing the bone strength or to decreasing the pace of losses that lead to easy fracture. Some fruits (such as guava & dates) & nuts (such as cashew & almond) can aid the process of bone maintenance. At an old age, a person will harm the health by taking carbonated beverages. Natural fruit juices are better alternatives.

Most of what I written above came from observations of old aged persons who never suffered from weak bones & kept being strong until they died. 

Nizar is onto something here--I have long maintained it is mostly about nutrition and I don't mean the chemist's version, but what the body considers nutrition--every nutrient in its vastly complex format, the kind the body thrives with. Even poor areas of the world that eat an organic diet mainly with fresh foods is better off nutritionally than the most advanced nation with a completely processed diet like we have here in the US--I don't mean to be disrespectful of our country, but processed foods and a sterile, mechanistic healthcare system is making us the chronically sickest people among advanced nations. 

And Jan is also onto something, but keeping in mind that collagen requires absorbed and metabolised ionically charged calcium, not the kind you buy at the local pharmacy--and therein lies the rub. Not specifying the type of calcium as that which is not typically commercially available is what is adding to the huge and corresponding rise in cases of atherosclerosis, kidney stones, cataracts (even in young people!), bone spurs, you name it--all the same condition in differing parts of the body, but in the current closed systems model of medicine, who is paying attention? All that excess free calcium with nowhere to go and almost totally unusable by the body--we keep hearing 10-15% absorption of supplemented calcium, but when are the alarm bells going to go off about the unabsorbed 85-90%? 

Dear all,

right now I found an announcing message in my mailbox (no warranty at all...):

Osteoporosis:

Essentials of Densitometry, Diagnosis and Management

An International Course of the ISCD and IOF For Physicians and Technologists

Saturday & Sunday November 15th & 16th, 2014, indicating ,

cf. www.imc.med.sa (Jeddah, Saudi-Arabia), got a lot of images with "meeting information"  but could not find any URL concerning that course in internet by googeling. Best regards, Wolfgang

again question iswhat aged patient we encounter and thesex of the patient and if it isa postmenopausal patient weexpect the osreoporosisto accoimpany the hormonal changes thataccompant thephenomenaanddepending on presence orabsence of ovariesonesupplements both calcium with theadditional vitamin d whose role is growing and highlighted and the changesin sewrum thyrioid function in that age has to be taken into account but in a ylounger patient role of thyroid in mineralisationm of bone has to bekept in mindandany other condition which can affect bone catabolism like parathyropiddisease etcforwhich a thorough work up becomesessential rather than simple therapy oraddition ofraloxiphene otany SERM with calcium but postmenopausalosteoporoticfracturesarewellknown andpreventive measuresare by replcement therapy like hormonal therapy besidescalcium vitamin dorwhateversupplementsaresoldor tibolone whichever is cionbenient depending on presence orsbsence of uterus and in males in oldageonehas to rule out any type of thyroiddidorder hyper/hypothyroidism asthyroid playsan important role andthen anythingaffecting calciumphosphorus metabolism like pasrathyroidanddetsailed history ofthyroidsurgery etc

Excellent information, Kulvinder. Thank you.

I fully agree with Dr. Nizar that poor nutrition is the most common cause of osteoporosis. Poor nutrition is the cause of many diseases.

i guess "Awareness" is one of the strong measures that could be taken  by both researchers and docs.

usually lifestyle and nutrition play key roles which modulate bone mass and other underlying mechanisms at molecular level. so, general awareness could be a very useful initiative to first keep a control over this disease,...

This absolutely what we need to do dear Kamal. Recent review added protein addition to your daily intake because bone mineral density increased with more calcium, protein and dark green vigitable even for elderly people. 

Movement, movement and movement! Physical activities. Reduction of time of sitting! (TV watching, computer, ect.)

problem in countries like india is half of such patients land up with drs who will just catch hold of them and replace there knees irrespective of cause as patient is unable top move a lot just to make money and you ask them to move agreed but since knees are in bad shape /some are in such pathetic condition that except for trying to convince the dietary habits and exposure to sun and agreed that no cchelating agents taken one has to emphasize not to get these unnecessary surgeries which are not going to help -we in developing countries have patients who are so poorly worked up for the cause and ethics is not the priority and poor patients land up with different kind of fractures for which answer is just surgery  without going deep into the cause -we have different strata one affluent who need to change habita like sitting on computers and others from villages who have an absolutely different lifestyle but both need to be addressed for the aetiology and address accordingly.

Dear Max,

A genuine examination by the clinician(Ethical practice)as one reader pointed out they go for Knee replacement, many times unwarranted and complications prone for any  major abnormalities is an absolute necessity, another key is "HEALTH EDUCATION" i would even say at the school level about the well balanced diet and exposure to the sunlight.

In some cultures where the females wear a complete dress coverage , we as a healthcare providers should exercise more efforts in the importance of sun expose to get the natural vitamin D.

I SUPPOSE ADDED SOME POINTS TO THE DISCUSSION. 

Sultan, you are most correct and I guess I had never really considered the consequences of those cultures who require complete dress coverage and the consequence of Vitamin deficiency in that population. As we have seen the very inferior performance of Vitamin D2 (which is actually quite toxic to the body with side and interaction effects all physicians shuold consider before prescribing) and the better but still inferior results of the Vitamin D3 recommendation compared to the Super D the human body produces with just 20-30 minutes of sun exposure to at least 15-20% of the skin surface area a few times a week, humans must have some significant sun exposure for optimal health. We hope enlightened people everywhere consider changing some of the traditional customs in this regard for the health of their society.

But we also know that even in cultures where skin cover is not so complete that just getting out of the office or market or wherever they are most of their day to get more sun exposure can be a challenge. Perhaps having their lunch outside, taking a midday walk during the wintertime, or enjoying more outdoor activities on their non-work days may be the answer. But even in those cases supplemental nutrients may be needed, which is why we advocate for EVERYONE taking (microcrystalline hydroxyapatite compound (MCHC), which has some of the digested Vitamin D from New Zealand sheep bones in live, ionic form rather than the dead, inert form commercially available. In other words, we feel it is crucial for health professionals to distinguish between differing levels of absorbance and recognize that supplemental nutritional which does not absorb thoroughly has the added problem of free calcium or whatever substance we are concerned with--any mineral in free form is not good for the body. The body may add ions to some of these to an extent and depending on age and sex (as without the aid of the sex hormones and other nutrients like boron even that makes little difference).

That is the reason for this discussion, to breakdown and discuss all these points. Speaking of exercise, nutrition, foods we eat, hydration, avoidance of caffeine and tobacco (major depleters of bone mass), sex hormones, age factors, detrimental effects of many medications in the long term...reduction of inordinate stress in lifestyle and work and relationships...all these things and more are the essential building blocks of discovery to lead to a more cogent discussion in the larger audience of humanity. The problem of severe bone loss is too great to do have any less frank treatment of the topic. 

even the populationswhere one has to be coverted it variesfrom different middle east countrieslike in saudi aranbiait is very restrictedandwomen have to be educated to expoosaethemse;lves to sun in the privateareawhewrethey can getaccess to sun although in other middleeast countries like uae,bahrai n it is more liberal andallthrey r need to be told to expose to sun sonmetime in dayand allof them dont even fully cover themselvesandqatar etcandegypt arealdo quiet liberal so one hasd to see the gewograogicareaandcustoms of theareaandpatientsfinancialposition aswell as thejob which may havea bearinmg on expoaure to some toxinsor anyother toxicagents like in lead factories etcand patientssocioecomnomicstatusregarding how much she or hecan affird nutririon wise.

This is a very simple problem,because western medicine can not understand reason about bone growth,however Chinese medicine understand cause - result bone growth,Chinese Medicine think bone growth is phenomenon , its root is "Shen" in Chinese,"Shen" is function not a organ, the function of "Shen" is to facilitate growth of bone,what can strength function of "Shen"? this is only one material named "Jing","Jing" just is semen, as human, we need do many things to keep semen as a full status,for instance,reduce life of sex,eat more  millet,reduce volume of fruit, do some exercise from Chinese Dao religion,you can find very good effect after two weeks,good luck to you!

Please read the following Ayurveda article on :

Proactive Management of Osteoporosis * Dr. Pranit Ambulkar and **Dr. Swati Rahangdale * National Institute of Ayurveda, Jaipur. ** Government Ayurved College, Nanded, India.

Abstract

Osteoporosis is the prime disorder in geriatrics. It cannot be cured or eradicated; only thing we do is to retard the progress. In order to prevent the osteoporosis, it is important to understand the patho-physiology of the disease. The Ayurvedic concepts of division of age according to Dosha and the theory of Rasayana are very well applicable in prevention of osteoporosis. Rasayana therapy is employed in young or middle age for the long term benefits lifelong and to delay the degenerative changes in old age. The efforts to prevent the osteoporosis in young and middle age according to Ayurvedic Rasayana concept can make the life easy after the retirement. The correlation of physiology of bone development and patho-physiology of osteoporosis with Ayurvedic principles makes the picture crystal clear about importance of proactive management of osteoporosis. So in whatever age group one is, it may be the high time to invest for one’s bone health. Also proper care and treatment is very is essential to avoid further complication in patients already suffering from osteoporosis.

Introduction

When we talk about geriatric problems, osteoporosis is the prime topic. Osteoporosis is loss of bone tissue, resulting in bones that are brittle and liable to fracture. Infection, injury and synovitis can cause localized osteoporosis of adjacent bone. Generalized osteoporosis is common in the elderly and in women often follows the menopause. It is also a feature of Cushing’s syndrome and prolonged steroid therapy. Many aged remain unaware of this underlying demon. Most of the times this problem is brought to notice by a bone fracture occurred due to a simple trauma. Females face osteoporosis earlier than males. In females loss of calcium and minerals begin often at the age of 30, where as in males it occurs after 60. In females it accelerates around the age of 45, as estrogen level falls down at menopause. 30% calcium is lost by the age of 70. Once bone loss begins, in females 8% loss occur every 10 yearly, where as in males 3% loss per 10 year occurs. Osteoporosis leads to too many problems like brittle bones, bone fractures, non union of fractures, pain etc. As at the old age, many therapies are inconvenient for patients, it is advisable to prevent osteoporotic changes right from the early age. Wealth is of no use if one doesn’t have good health to enjoy the life. So, a little care for our bone health from young age will be definitely a worth and wise investment for happy life after retirement. Composition of bone Bone is a live tissue. It contains following types of cells. Osteoblasts, osteoclasts, osteocytes and osteoprogenitor or mesenchymal cells. Out of which Osteoplasts are with single nucleus. They deposit new bone. Osteoclasts are the giant cells with 15-20 nuclei. They may have up to 100 nuclei. They cause resorption of bone. About 80% of human skeleton is compact bone and 20% spongy bone. Adult compact bone contains about 75% inorganic and 25% organic materials. (Dry weight.) Compact bone tissue is arranged in units called osteons or Haversian system. Bone contains mainly calcium, magnesium and phosphorus as its inorganic material, in which calcium is the major. Calcium 99% of total body calcium (which is 1 Kg) is in bones. Calcium salts gives the bone its hardness. Magnesium 50% of total body magnesium occurs in bone. 5% in extra cellular fluid and 45% in cells. Mg behaves like calcium on neuromuscular system. Phosphorus 80% of total body phosphorus is in the bones. Other phosphorus is intracellular. Collagen It is also an important protein content of bone Bones according to Ayurveda According to Ayurveda, bone i.e. Asthi is the 5th dhatu in our body. Asthi is so called because it remains for longer time, even after death. Bones decomposes at last. Asthi has panchabhautic constitution and it exhibits properties of Prithvi mahabhuta more prominently. Asthi are one of the destinations of Vayu (Vata sthana). The Vayu and Asthi are inversely proportional to each other. That means when Vayu increases in Asthi, Asthi decreases, and vice versa.

Growth & Development of Bones

Bones calcify through the process of ossification. Bone ossification begins at 6th- 7th week of intra uterine life. As per length wise growth of bones is concerned, the activity of epithelial plate is the only way that the diaphysis can increase in length. Calcium 99% of total body calcium is in bones. The calcium of the bone is in dynamic equilibrium with the calcium in extra cellular fluid (E.C.F.), i.e. the calcium leaves the bone to enter E.C.F. and the same time the E.C.F. calcium deposits in the bone resulting in no net loss or gain in the total calcium of bone. This is seen in adults and called as calcium equilibrium. In growing child positive calcium equilibrium is observed. That means, new bone formation is more than the depletion of bone in the remodeling. While in elderly person, negative calcium balance is observed where bone loss is more than the new bone formation. Many factors other than calcium play an important role in bone development. Vitamin C It is needed for the synthesis of main bone protein collagen. And also for the differentiation of osteoblasts into osteocytes. Vitamin K & Vitamin B12 These are also needed for protein synthesis. Vitamin A This stimulates activity of osteoblasts. Three hormones take part in regulation of bone formation. 1. Vitamin D (de hydroxy cholecalciferol) 2. Small intestine and bone are the principal target organs for vitamin D. 3. Para thyroid hormone (PTH) It acts on bones, kidney, and intestine. It induces high serum calcium level and decreases calcium from bones. Calcitonin It takes part in calcium metabolism. Its exact role is not known in human. Nutrition of bones according to Ayurveda Bone, as per its Panchabhautic constitution mainly gets its body mass from the nutrient which is prominently Prithvi mahabhautic in constitution. According to Uttarottar dhatu poshan nyay (nutrition of successive dhatu) Asthi gets its nutrition from majja. Majja can be co-related with red and yellow bone marrow. Need of early age bone care As mentioned earlier, positive calcium balance is observed in young age, calcium equilibrium is observed in middle age and negative calcium balance is observed in old age. That means if one wants to buildup a good health of bones, the young age is the most ideal period. Efforts in middle age may also be fruitful. But as an old age is a degenerative stage, even vigorous efforts to boost body components may not prove encouraging. In reference to the Rasayana i.e. rejuvenating treatment, Ayurveda has clearly mentioned to have Rasayana at young age or middle age by the sentence, ‘Poorve Vayasi Madhhye Wa…’. Though the target is to prevent disorders at geriatric age, the treatment is prescribed at the developing age of the human body. If we consider the stage of Dosha at different age groups, in young age Kapha Dosha is prominent which is responsible for cumulative and integrative action. In middle age Pitta Dosha is prominent whereas in old age Vata Dosha is prominent. As Vata is inversely proportional to the Asthi, efforts to treat osteoporosis at elder age are less effective. On the other hand if we follow the principle of Rasayana and start Rasayana for bones at young age or middle age, it will be beneficial for life long. Not only for bones, but also this theory is applicable for all dhatu and whole body. Constructive work is always recommended in constructive age, which is young age. So, attention towards early age management of geriatric problems like osteoporosis is essential. Early age bone health care is not only important in point of view of prevention of osteoporosis, but also it is important in primary growth and development of child. Because few things are irreversible and that’s why should be taken care when formation is going on.

Like :

a) Teeth Like bones, calcium is the main constituent of teeth. According to Ayurveda, teeth are derived from bones and called as Updhatu of it. At the time of dental development, if child lacks in nutrients, minerals or the factors which make the nutrients available for development, the child will not get healthy teeth. As the calcium in teeth can not be mobilized, after the completion of development, these teeth remain weak for life time. Dental caries, early teeth loss and related complications are common with these sorts of people in adulthood. If proper care of bone health is taken at child hood, it will serve for the healthy development of its Upadhatu i.e. teeth for life long. b) Height Height of a person is completely dependant on the lengthwise growth of long bones. The activity of epiphysial plate is the only way that the diaphysis can increase in length. Any damage to the epiphysial plate in a form of trauma, infection, etc may hamper the growth of that particular bone. Malnutrition, insufficient supply of nutrients required for bone development can result into short height. Also obesity can be a hurdle for height wise growth in children. Because, Tissue like adipose tissue can convert androgens to estrogens. As ultimately the sex steroid, especially estrogen in both sexes shuts down growth at epiphysial plate, no further bone elongation occurs. So bone growth remains stunted in children. Hence proper attention towards the development of bones can save one from lifetime frustration of stunted height and related. How can one take care of bones? In order to gain a good bone health following few points plays an important role. Sufficient intake of nutrients Absorption of nutrients Transportation of nutrition to desired sight Appropriate formation of the target tissue / dhatu. Accessory or accompanying components like Prakriti, age etc. a) Nutrients for Asthi (bones) According to Samya-Vaishamya theory of Ayurveda, drugs having similar constitutions as Asthi are useful for the nutrition of Asthi. For example, calcium rich diet like milk and milk products, eggs, fish, green leafy vegetables like spinach, amaranth; cereals, millets, some fruits like custard apple (Sitaphal) provide good calcium supplement. An additional source of calcium is drinking water which may provide up to 200 mg/day. Also the plant drugs having their core boney hard are used to strengthen the bones.

 Drugs rich in calcium may be occasionally used to compensate deficiency.

b) Jatharagni & Digestion of food Digestion of food plays an important role in nutrition of bones, one and all. Food is the main source of calcium and other essential nutrients. According to the concept of Ayurveda, Agni is the digestive power in the body. It is the factor responsible for any transformation in the body. Jatharagni digests the food and makes it available for the absorption in body. Unless the Agni is functioning properly, whatever nutrients we eat will not be beneficial for the body completely. The jatharagni can be compared with the cumulative function of gastric juices, gastric acidity, bile and digestive enzymes together. The function of Agni can be illustrated as follows, Hunger and thirst are caused by Agni at meal time. When person is hungry, gastric juices are secreted in more quantity. For absorption of calcium gastric acidity is of great help. Calcitonin decreases serum calcium and prevents bone resorption. Calcitonin secretion is stimulated when there is secretion of gastro-intestinal hormones, gasrtin and cholecystokinin – pancreozymine which are secreted after meals. In this period calcium absorption from the gut rises, this is well established. This way serum calcium does not become dangerously high and extra calcium in serum coming from food is deposited on the bones. In addition glucagons also stimulate it.

c) Grahani & absorption of nutrients

Native place of Agni or pitta is ‘grahani’ which is anatomically compared with duodenum. The well function of grahani is said to be responsible for good digestion of food. Also it functions for differentiation of nutrients and waste products, absorption of nutrients, formation of urine and faeces etc. The importance of Grahani can be explained in following manner. Daily requirement of calcium is 0.8 gm/day in adults. It may be less than even 0.5 gm/day. If the dietary calcium intake is low, the absorption of calcium by intestine becomes very avid. Whereas where the dietary calcium intake of the calcium is high, the intestinal calcium absorption becomes poor. Thus the intestine regulates the calcium by adjusting the absorption of calcium. This adjustment of absorption is made possible by changing the availability of 1, 25 dehydroxy cholecalciferol (a vitamin D derivative). Active transport against concentration gradient depends on 1, 25 dehydroxy cholecalciferol which occurs in the duodenum. Passive diffusion occurs in small intestine in small amounts i.e. nearly 15%. Where 1, 25 dehydroxyl cholecalciferol is low, calcium absorption also decreases. Total calcium we get is from dietary calcium and calcium from G.I. juices. In this way the Agni and grahani plays a main role in nutrition of bones. Thus the efficient digestive system leads to good nourishment.

 d) Bhrajakagni &Vitamin D Another form of Agni that regulates the bone formation is Bhrajakagni. This can be explained as the digestive power that digests the nutrients from skin and make it available for body. It also illustrates the skin colour. Vit. D is formed under skin in presence of U.V. rays in sunlight. Vit. D3 irradiated dehydro cholesterol. Small intestine and bones are the principal target organs. So, the Bhrajakagni should be proper for proper formation of vitamin D. Also enough exposure to the sunlight is essential. Massage with oil and then fomentation with steam or warm water is also a good exercise to worship the Bhrajakagni. Food material like liver, egg yolk, butter, cheese, milk and other milk products, fish, fish liver oil are consumed as vitamin D supplement. e) Dhatwagni & formation of target Rasa (lymph/serum), Rakta (blood), Mamsa (flesh), Meda (fat), Asthi (bone), Majja (marrow), Shukra (semen) are the 7 dhatu that constitute the body. Nutrient material from the digested food is separated in grahani and picked up in the circulatory system. Saptadhatwagni works for digestion of useful component of digested food for the formation of respective dhatu. Asthi dhatwagni digests nutrients for the nourishment of bones.

In blood calcium occurs in serum. On average serum calcium level is 10 mg/ 100 ml. about half of this i.e. 5 mg/100 ml occurs in ionized form. This is the active form. Of the rest 50%, most i.e. about 4 mg/100 ml bounds with the serum protein. The rest  mg/100 ml occurs in complex with citrate and phosphate. The combine amount of complex calcium and ionized calcium is the ultra filterable calcium of serum. Also it is called diffusible fraction. It is not important what level of calcium is in the serum, but the most important thing is its usable fraction and the dhatwagni that makes it available for use in body. For example, in condition of severe protein malnutrition, protein bound calcium decreases but ionized calcium remains normal. As a result, total serum calcium decreases but patient doesn’t suffer from calcium deficiency syndrome. On the other hand, when blood pH increases protein bound fraction of calcium in serum increases. Hence in alkalosis though total serum calcium level remains within normal limits, patient may suffer from tetany, the calcium deficiency symptom. In this way normal functioning of dhatwagni is important for appropriate use of available nutrients. As the dhatwagni is responsible for the utilization of available nutrition from circulation for the nutrition of specific dhatu, it is also important to maintain dhatwagni in proper function. As the jatharagni is the governing Agni, maintenance of jathragni serves for welfare of all other Agni in body. Also specific medicines are used for boosting of specific Dhatwagni.

Treatment of Asthisaushirya (Osteoporosis)

As the precautions described earlier, the treatment can also be divided into various categories as follows.

a) Nutrition: All essential nutrient elements as described earlier should be included in diet in adequate quantity. Calcium containing drugs like Prawal panchamrit, Bhasma of Kukkutand twak (egg shell), Shankha, Shukti, Varatika, Mukta (pearl), Prawal (coral), and Ajaasthi should be used. Even adequate exposure to sunlight is necessary to get vitamin D. In addition to that, Rasayana drugs like Chyavanprash, Brahma Rasayana, Shilajatu Rasayana, Agastya Haritaki shows good results.

b) Digestion: As digestion plays an important role, much attention is needed towards this. Rather this issue should be considered at first, because improper digestion is the root cause of most of the diseases. Indigestion results into ‘Aam’ that is responsible for Srotorodh- a sort of obstruction in the systemic functions of body is also a product of improper digestion. Aam pachan and dipan drugs like Kravyada rasa, Chitrak Haritaki, Hingwashtak churna, Lavanbhaskar churna, Jeerakadyarishta, Drakshasava, Panchakolasava can be taken for that.

c) Dhatwagni: As the amount of nutrients like calcium is not required in much quantity, on the contrary over intake of calcium retards its absorption through gut. Hence drugs modifying the dhatwagni to improve absorption and deposition of calcium should be used. 

d) Exercise: Proper exercise certainly improves bone health. Bones undergoing stress are remodeled as a tough one. Exercise like jogging, weight lifting, sit ups and other weight bearing exercises can help a lot.

e) Snehana: As Asthi and Vayu are in inverse proportion, use of Sneha like oils, ghee, vasa, majja are useful to reduce hollowness of bones. Snehanea in form of Snehabasti, Majja Basti, Tikta ksheer basti, Sidhha Ghrit basti, external application and internal consumption is useful. Also Tiktak ghrit, Mahatiktak ghrit are useful. Swedana (fomentation) followed by Snehana is also useful. Panchakarma as well shows good results.

f) Menopausal treatment: In case of females, special attention should be given. Because hormonal imbalance at menopause is responsible for osteoporosis there. Treatment for menopausal syndrome must be followed along with above mentioned things. Also regular check up is advisable to rule out progress.

References 1. Harrison’s principles of internal medicine, 16th edition 2. Guyton’s textbook of medical physiology, 11th edition 3. Rasa yoga sagara by Hariprapanna Sharma 4. Chakradatta- Rtnaprabha commentary by Nishchalkara 5. Ashtanga Sangraha- Indu commentary (CCIM)

Thank you, Giammichele and all of you, for great comments and perspectives and insights. I agree with the vast majority of what has been expressed. The only place I depart, because I have seen reversal of osteoporosis without the risky (osteoclast) medications that that used in the US--not complete reversal, but up to an 70-80% reversal where blood flow to the bones, osteoblast activity, and normalized cellular pH of the body and reduction in bone-losing elements like caffeine and medications in general, and if the individual completely stops microwaving their food (opting instead for convection, grilling, steaming, baking, etc.,) and eats a diet where at least 50% of vegetables and frutis are uncooked, and introduced weight-bearing exercise (and yoga in many cases), and get the sunlight exposure one requires, along with a happier, more engaged lifestyle, we see almost miraculous changes take place in all but possibly the most advanced cases of osteoporosis.

Here is how we state it--versus the official line that it cannot be cured or improved by anything but medication: Osteoarthritis, Osteopenia (a made up condition to sell more drugs, in our opinion) and Osteoporosis can be largely prevented as we grow older by the things discussed here and above. In many cases, these changes cause a "blossoming" effect on the individual, such as increased microvascular flow, thickened skin, self-resolved cataracts, kidney stones, and atherosclerosis, restored neural and motor function, improved metabolism and cellular pH (via re-established Kreb's cycle), oxygenation of the blood (with corresponding ridding of CO2), cartilage and bone regeneration, and renewed cognitive and spatial function. This is achievable if the individual will do what it takes, at any age. It takes more time to achieve as we get older, and it is reliant upon the mitochondria's ability to achieve and maintain homeostasis. Anything less than this model of health, to us, is inferior. It does not distinguish between live (ionically charged) or inert calcium, treating them as if they are the same thing. Too much inert calcium causes cataracts, kidney stones, atherosclerosis, bone spurs, and heretotopic ossication (the same condition of acidosis manifesting in many parts of the body). The quality of food matters immensely, the more processed the worse it is for humans. Hydration and quality of water matters. Air quality matters. Naturally and gently chelating out the heavy metals that are found in water, air, food, and manmade products is essential and cannot be left out of the equation. Removal of as many toxins as possible from human exposure is critical. Use of medications primarily for acute disease and rarely for chronic disease, instead opting to get to underlying causes, is essential. All of these things I bring up would upend the entire Western medical economic model, which thrives on managing not healing, bullying instead of nurturing, and big dollars of patented toxins instead of the nearly free treatment of natural and organic substances. This is the way to change the scenario and it will have lots of opposition from some quarters. Nevertheless, there is no more ideal or effective way to go if we truly want our populations to reverse the current trends.            

Dear Prof. Chartrand, we studied & reserched a lot on Shilajit and old herbal preparation (which one of the ingredients is shanka bhasma "calcium carbonate" from Turbinella rapa conch shell aclcinated), both Ayurvedic origin that they could support & prevent. I shall better explain next week on. Excuse me I'm transfering, still now, my association/institute & company in a new place in Bologna. All my bes

Hi everybody!

I read with a lot of interest the comments and reactions published above. I can just subscribe to Prof. Chartrand- there is a need to change the mind settings of health care providers, education providers and the last but not the least the profit oriented pharma and food industry practice. Our life style makes us sick- we have office light instead of sun light, we have cars instead of walking, we have microwave food instead of family lunches/dinners, we are eating and living in a hurry forgetting our meaning as human beings. We try to fix things if possible with a pill, or to reach for immediate solutions even if painful or costly. We are meant by nature to move, to walk, to breath in  open spaces and not in air condition environment, to enjoy the sun and not to aply sun screens of factor above 30. At least, to become aware that the ageing with grace is possible and reachable if we resonate with the nature.

It is said that all beautifull things in life do not cost money- as walking, gardening, preparing your food with love and eating with the loved ones, meditation, awareness, getting aligned with nature. Otherwise we will be the architects of our own destruction.

With reluctance I have to say that there has been a lot of "as a matter of fact" contributions without much scientific backup. Throwing regional terms at us is not making it more credible either, nor do inaccessible books and citations from gurus. Now, I do appreciate that any disease can be reduced in the population when we would all adopt a healthier lifestyle. And I also appreciate it that bones need maintenance not only by nutrition but also by active use of them. Do not use them, and they deteriorate. Proven by less mobile people and by space research (long exposure to micro-gravity).

The question though is what health care providers and researchers can do. Telling the world to live healthier or eat this or that is not an answer to this question and not very practical either. Clearly not all individuals are equally prone to osteoporosis. This suggests genetic trades in addition to environmental factors. Something which is true for many modern day diseases like cancer, CVD and dementia. Science should be able to find the culprits by looking at the genetics, the epigenetics, biomarkers and any environmental factor that might be relevant. Only extensive research can provide these insights. Banning the microwave will not be a medical solution.

Researchgate is (meant to be) a scientific platform, not a portal for alternative lifestyles. The calcium aspects discussed above are intriguing and confusing. Max, I would love to see your clinical observations translated into hard figures!

I apologize for my non scientific remarks which I previously posted which is seemed to have caused some irritations. Please be so kind and ignore them. Thank you.

Jan, you hit upon the conundrum of good health by living healthy--self evident and not worth the expected millions verifying it. Instead billions of wasted dollars (from a scientific standpoint) are spent on psuedoscience to try and convince us that preventing osteoclasts from doing their job and filling up depleted bones with dead bone cells is the best way to go. There are ample studies showing the benefits of each of the things mentioned above--I gave a few of them by citation in my opening above. Sprinkled in there are other contibutions. But the logic factor has been left out of the scientific argument: why would anyone advocate dangerous biphosphonates etc. for bone loss with its dangerous risks and over-interpreted/biased data?? From a public health viewpoint we would be advocating what has been advocated thus far instead of the current treatment practice. I know it doesn't come across scientific when we speak of logic, because the purpose of self-evidence does not pose a gap in the literature waiting to be filled in with research. It is the Zeigeist of our day that poses these [ignoring the] elephant in the living room inquiries need more convincing. But the posing is done within the financial schemata. Who in their right mind would spend billions to prove that getting adequate sunlight produces a far superior vitamin D that costs nothing over the toxic and incomplete chemistry of the prescribed D2 that creates MORE illness? Who would spend the money to prove weight bearing exercise in a sedentary world significantly reduces bone loss?

But your larger point is made and I concur. Most of us are working 18 hour days and barely able to keep up with publishing and other deadlines, which gives a quick moment here and there to actually provide links to the studies relative to the self-evident statements we make. But I will be the first to admit mea culpa--and get on the stick of providing more evidence. Thank you for alerting us.

here i tend to agree with dr max regarding unnecessary use of bisphosphonates and more the physiological methods we use to get the bodies system to work ve it reduction in obesity,more natural sources of calcium ,vitaminAD like sunlight rather than so much overloading of medicines of wjhose xomplianvce we are not sure and ensuring normalk krebs cycle ph and all hormonal para,meters toi ensure more bo ne laying like iin obese parients prebiotic treatment helps inm greater calcium retyention and bone accretion and bone mineral density both in adoleascents and less in post menpausal women and both loss of weight by itself helpd in ambulation in such cases and vivious cyycloe gets broken of dsede4ntary life.

Dear Professor Max Stanley Chartrand,

Because Osteopenia can cause bone fractures and therefore, it is important and to be of attention and requires public awareness.

In addition to the pain, hip fractures are a serious problem because they require surgical repair. Other complications may arise due to this are blood clots related to immobility, pneumonia, and many others.

Let us start doing exercise and and think about gaining with calcium and vitamin AD.

Yes, but live form of bone meal is the best, and if taken interically all the better. Inert calcium creates lots of problems like cataracts, atheroschlerosis, kidney stones, bone spurs (all the same process of dead/unabsorbable calcium manifested in different parts of the body), etc.  is important to get our calcium from live sources. 

the problem we face in our population is that a lot dont take nonveg and i dont know if you refer to live form of bone meal to nonveg or milk as because of a lot of religious and spiritual reasons nonvegetarian is not consumed by a lot of our popuylation  so milk or its products remain the only alternative in that scenarion besides the natural sunlight  which is easily availaBLE IN TROPICAL COUNTRIES LIKE OURS .

Dr. Kulvinder Kochar Kaur,

Besides milk, a form of calcium that is widely found in your country is sesame seeds. Raw unhulled brown sesame seeds are high in calcium–about 351 mg. per 1/4 cup (approx. 36 gm), or 280 mg./oz. Soaking and sprouting seeds and grains releases the enzyme inhibitors and phytate-bound calcium (and zinc and iron) during the germination process. This makes the calcium more bio-available.

Dr. Chartrand, the soaking/sprouting also makes this a live source of calcium, acceptable to vegetarians and vegans, unlike bone which may also contain toxic contaminants. Green leafy cruciferous vegetables, such as kale, collards and broccoli (180 mg./cup) provide dietary calcium, with little of the calcium-binding oxalic acid in certain vegetables such as spinach. Other vegan foods such as acorn squash, carrots, certain fruits and almonds also contribute to vegan dietary calcium.

Black sesame seeds have a higher iron content, and the calcium content is both lower and less available, since calcium and iron can compete for absorption.

To prevent osteoporosis, of course Vit. D is needed, and more freely available in Dr. Kulvinder Kochar Kaur's climate than mine!

Rosi, thank you for an excellent foray into vegetable source calcium and iron. From time to time I need to clarify for our contributors (not you, by the way) that calcium is not necessarily calcium when it comes to bioavailability. In other words the body only wants and easily accepts calcium or any other mineral (you mentioned iron) that is in live form--fruits, nuts, and vegetables are by far the best source--but only IF they are not irradiated as so much of such foods are in this country before it even reaches the stores. There is a profound ignorance in the field of nutrition in particular and in the public in general that the body does not know the difference between these different forms of nutrition--ascorbic acid is NOT vitamin C as it occurs in nature---but try debating that point with a highly educated nutritionist who has been taught that the synthetics are as good as anything nature can put out. You mentined bone meal could have contaniment, and indeed most commercial forms are laced with arsenic, lead, cyanide, formaldehyde, mercury, etc. That is why I suggest only interically-released MCHC for that source instead of the generic form of bone meal. It essentially has no contaminents and is packaged in live form. We have found it the fastest way to overcome osetoporosis of any approach seen to-date. Iron, another huge misnomer in health circles today, should ALWAYS be the predigested type found in food, not the deadly and toxic form found in elemental iron that is added to food and vitamin pills. Again, once irradiated it is anyone's guess how much of anything with ions still exists. Thank you again for your excellent comments--I've not doubt that we are essentially on the same page on this.